The City’s ‘Two-Case’ Rule On School Reopenings Didn’t Follow CDC Policy. So What Comes Next?

Mayor Bill de Blasio confirmed Monday that he is planning to change the current policy on COVID-19-related school closures, which has created frequent disruptions to in-person learning and frustrated many parents. The rule requires a school building to close for 10 days after two unlinked coronavirus cases are detected among staff and students.

While the mayor has acknowledged that the policy is out of step with current recommendations from the Centers for Disease Control and Prevention, he has yet to present an alternative. Meanwhile, epidemiologists and doctors have said evidence supports a less restrictive approach.

The announcement that the city would get rid of the rule came two weeks after de Blasio reopened enrollment for in-person learning for the current school year. On Monday, the mayor said he is extending the opt-in deadline from Wednesday to the close of business on Friday. He reasoned that the elimination of the two-case rule might make in-person learning appealing to more families. But critics say that it will still be difficult for parents to make an informed decision without details on a new policy.

“We’ve got a little more work to do on the new rule,” de Blasio said Monday. “We do want to talk to all the organizations, the unions that represent the folks who work in our schools and go over the evidence we have with them and go over what the new rule will be, and we’ll have that announcement in the coming days.”

While the two-case rule uses the number of positive tests among students and staff to trigger a school closure, the CDC’s guidelines focus more on the case rate—the number of incidents per 100,000 residents of an area—and the transmission level within a school and its surrounding community. The CDC’s recent guidance on school safety indicated that in-person learning may be suspended in the event of “uncontrolled spread” within the school or if it is located in a district “experiencing rapid or persistent rises in COVID-19 case rates or severe burden on health care capacity.”

New York City already uses a similar color-coded system to identify neighborhoods that are COVID-19 hotspots and has used these designations during the pandemic to trigger school closures.

“They should consider opening based on local conditions,” said Dr. Viju Jacob, who is on the American Academy of Pediatrics Council on School Health Executive Committee. “If that ZIP code or borough has a big outbreak, schools there might have to do more hybrid or virtual learning for a while, but it shouldn’t be a rule across the board.”

Jacob has observed how the two-case rule has been detrimental to students’ education and health in his role as vice president for medical regulatory, policy and external affairs at Urban Health Plan, a system of community and school-based health clinics in the Bronx. He noted that without in-person learning, kids have missed out on things like healthy meals and interactions with teachers and staff. That contact could help identify mental health issues or trauma.

The two-case rule was “a reasonable place to start” when less was known about how the virus spreads, Jacob added. Studies worldwide have shown that in-person learning, particularly with proper mitigation measures in place, is not substantially related to community transmission of COVID-19. These trends have been prioritized in the guidance presented by the CDC. Data collected in New York City so far also supports in-person learning.

Read More: Why NYC School Closures Might No Longer Be Needed

“Our schools remained safe even as we battled through a second wave this fall and winter, which demonstrates that we can protect staff and students even when there is significant community transmission,” Dr. David Chokshi, the city health commissioner, said Monday. “The way to beat COVID is not by closing schools excessively but by suppressing transmission both inside and outside of schools by focusing on the fundamentals: Handwashing, distancing, ventilation, masking, testing and getting vaccinated.”

Still, Chokshi and the mayor have held off on offering any hint of what an alternative policy could look like.

“I’m glad the Mayor is admitting that the 2-case closure rule doesn’t make sense and is destabilizing school schedules,” Councilman Brad Lander said in a statement Monday. “But it’s ridiculous that, two months after saying they were reviewing it, the administration is announcing that they are planning to get rid of the rule and still don’t have a plan.”

Dr. Elissa Schechter-Perkins, an infectious disease expert who co-authored a recent study that led the CDC to change its guidance on physical distancing in schools, says she thinks there should be a more targeted intervention if a positive case is discovered.

“It would make sense if there is a positive case for close contacts to be notified and either tested or quarantined—and the rest of the class and building to continue operating normally in person,” she told Gothamist/WNYC. “If there are multiple cases in a classroom without outside exposures that raise concern, then there might have been in-school or in-classroom transmission. [In that case], it makes sense to temporarily close that classroom while it’s investigated, but that should be exceedingly rare.”

Schechter-Perkins added that if a classroom is closed, there should be an investigation into whether there were lapses in safety measures such as mask use, which she says is frequently the culprit for in-school transmission.

Experts who spoke to Gothamist/WNYC disagreed on how much focus should be placed on surveillance testing, which can be expensive and labor-intensive. Dr. Andrea Ciaranello, an epidemiologist at Massachusetts General Hospital who has advised school districts around Massachusetts, is a big proponent of widespread testing. She said such surveillance could help detect and isolate asymptomatic carriers. New York City currently tests 20% of students and staff on a weekly basis, but Ciaranello said it “would be ideal to do a larger portion” of those in the school building.

Dr. Schechter-Perkins and Dr. Jacob said they support testing in general, but countered that rather than expand surveillance testing, it would make sense to invest more resources in tracing, so close contacts of anyone who tests positive can be found faster and before they spread the disease onward.

The United Federation of Teachers has so far resisted any change to the two-case rule. In a statement responding to Mayor de Blasio’s announcement Monday, UFT president Michael Mulgrew indicated that he was still short on details about a replacement policy and no closer to supporting one.

“A proclamation is not a plan,” Mulgrew said, adding that “Any change to the two-case rule has to take the safety of children and their families into account, not the mayor’s need for a Monday morning announcement.”

De Blasio insisted on Monday that parents do not need to know the details of the new policy to decide whether to opt into in-person learning. “We know that any other standard will lead to a lot fewer closures,” he said. “That’s what parents want to know.”

Epidemiologists and doctors say any policy the mayor puts in place should balance the risk of spreading COVID-19 with other risks to children’s health and education.

“One could choose a strategy that’s very, very conservative with regard to COVID risks but then not at all conservative with regard to those other risks,” said Dr. Ciaranello. “It makes sense to be a little less conservative with regard to COVID risks.”